title: The use of transient elastography and non-invasive serum markers of fibrosis in pediatric liver transplant recipients.
abstract: The use of non-invasive markers to diagnose liver allograft fibrosis is not well established in children after LTx. TE, FT, and ELF score were performed in 117 liver-transplanted children (60M, 8.9 [0.5-18.5] yr) and 336 healthy controls. Liver biopsy was available in 36 children. Results of histology and non-invasive markers were compared using correlation coefficient or Mann-Whitney U-test as appropriate. TE correlated best with histological degree of fibrosis (r = 0.85 vs. r = 0.04 [FT] or r = -0.38 [ELF]). Liver stiffness values for transplanted children without fibrosis were significantly higher than those of healthy controls (7.55 [5.4-20.4] kPa vs. 4.5 [2.5-8.9] kPa). Presence of rejection was a potent confounder for the performance of TE. Both TE and FT reflected clinical changes (acute rejection, cholestasis, increasing fibrosis) in a total of 16 patients who underwent serial measurements. TE correlates better with histological degree of fibrosis in liver-transplanted children than FT or ELF, but an individual baseline value needs to be determined for each patient. Normal or cutoff values for pathological degrees of fibrosis cannot be transferred from non-transplanted children. Follow-up studies, preferably with protocol biopsies, might help to improve the diagnostic quality of TE.
authors.affiliation: Pediatric Gastroenterology and Hepatology, Department for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany. goldschmidt.imeke@mh-hannover.de
authors.forename: Imeke
authors.initials: I
authors.lastname: Goldschmidt
authors.forename: Henrik
authors.initials: H
authors.lastname: Stieghorst
authors.forename: Mona
authors.initials: M
authors.lastname: Munteanu
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.forename: Jerome
authors.initials: J
authors.lastname: Schlue
authors.forename: Carolin
authors.initials: C
authors.lastname: Streckenbach
authors.forename: Ulrich
authors.initials: U
authors.lastname: Baumann
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology; D017093:Liver Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: elastography; fibrosis; liver transplantation; pediatrics